University Hospitals Cleveland Medical Center is the flagship academic medical center at the core of UH’s 18 hospital health system that serves patients across northern Ohio. Through faculty appointments at Case Western Reserve University School of Medicine and through research conducted with support from UH’s Harrington Discovery Institute, physician-scientists at UH Cleveland Medical Center are advancing medical care through education and innovative research that brings the latest treatment options to patients regionally and around the world.

Headache

What is a headache?

A headache is pain or discomfort in the head or face. Headaches vary greatly in terms of the location and intensity of the pain, and how often the headaches occur. The brain tissue doesn’t have pain-sensitive nerve fibers and doesn’t feel pain. But, other parts of the head can be responsible for a headache including:

A network of nerves that extends over the scalp

Certain nerves in the face, mouth, and throat

Muscles of the head, neck, and shoulders

Blood vessels found along the surface and at the base of the brain

Different types of headaches include:

Migraine

In this type of headache, symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur with migraines. Migraines also have distinct phases. Not all people have each phase, however. The phases of a migraine headache may include:

Premonition or prodromal phase. A change in mood or behavior may occur hours or days before the headache.

Aura phase. A group of visual, sensory, or motor symptoms can precede the headache. Examples include vision changes, hallucinations, numbness, changes in speech, and muscle weakness.

Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.

Resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, others do not.

Tension headaches

Tension headaches are the most common type of headache. Stress and tight muscles are often factors in tension-type headaches. These are common symptoms of a tension-type headache:

The eye that is affected may be red and watery with a droopy lid and small pupil

Swelling of the eyelid

Runny nose or congestion

Swelling of the forehead

What causes a headache?

Headaches are classified as primary or secondary.

A primary headache means the headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medicines, dehydration, or hormone changes.

A secondary headache is related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection.

What are the symptoms of a headache?

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of the symptoms may vary, too. Typical headache symptoms include:

The symptoms of a headache may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is a headache diagnosed?

Your doctor will want to do a comprehensive medical evaluation and diagnostic testing. He or she will also ask about your medical history, and do physical exam and certain tests.

Questions commonly asked during the exam may include:

When do headaches occur?

What is the location of the headache?

What do the headaches feel like?

How long do the headaches last?

Have there been changes in behavior or personality?

Do changes in position or sitting up cause the headache?

Do you have trouble sleeping?

Do you have a history of stress?

Is there a history of head injury?

If your doctor suspects migraine or tension-type headaches and the neurological exam is normal, no further testing may be needed. However, if it is not a primary type headache, then other tests may be done to find the cause.

Tests used to find the cause of a headache may include:

Blood tests. Various blood chemistry and other lab tests may be run to check for underlying conditions.

Sinus x-rays. An imaging procedure done to evaluate for congestion or other problems that may be corrected.

Magnetic resonance imaging (MRI). A test that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Computed tomography scan (also called a CT or CAT scan). An imaging test that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Abortive medicines. Medicines prescribed by your healthcare provider act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.

Rescue medicines. Medicines bought over-the-counter, such as pain relievers, to stop the headache.

Preventive medicines. Medicines prescribed by your healthcare provider taken daily to reduce the onset of headaches.

Some headaches may need immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

Can headaches be prevented?

When headache triggers are known, avoiding the triggers can prevent a headache. Reducing stress can minimize or prevent headaches caused by stress. Migraine and cluster headaches may be prevented by taking a daily preventive medicines.

When should I call my healthcare provider?

Most headaches can be managed with over-the-counter pain relievers. However, call your healthcare provider right away if a severe headache is accompanied by:

Stiff neck

Fever

Nausea

Vomiting

Convulsion

Shortness of breath

Confusion

Muscular weakness

Double vision

Change in level of consciousness.

Symptoms that may suggest a more serious headache include:

Worst headache ever, or new type of headache

Recurring headaches in children

Headaches that start early in the morning

Headache that follows a head injury

Pain that is worsened by strain, such as a cough or a sneeze

Vomiting without nausea

Sudden onset of pain

Headache that is becoming more severe or continuous

Personality changes

Seizures

Key points about headaches

A headache is pain or discomfort in the head or face area.

Types of headaches include migraine, tension, and cluster.

Headaches can be primary or secondary. If it is secondary, it is caused by another condition.

Avoiding headache triggers is the best prevention.

Mild to moderate headaches can be managed with over-the-counter medicines, but tell your healthcare provider if your headache is severe and you have other symptoms.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how will you get the results

Who to call after the test or procedure if you have questions or problems